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April 1, 2007

'Can you fix my ears?'

From: Louisville Courier-Journal - Louisville,KY,USA - Apr 1, 2007

As more children receive a second cochlear implant, questions rise about cost … and the value of hearing itself

By Laura Ungar
The Courier-Journal

Jaden Young's question recalled his late mother's greatest wish.

"Can you fix my ears?" the 7-year-old asked his father, John, last winter.

Jaden was born profoundly deaf, and his mother, Natosha Rhyne, had worked tirelessly to make sure he got a cochlear implant as a baby.

The device allowed him to hear in his right ear, but Rhyne hoped he would someday hear with both ears.

Less than a year after she was killed in a July hit-and-run accident, her wish was fulfilled as Jaden became one of the first Louisville children to join a small but growing group with two cochlear implants for stereo hearing.

Adding the second implant is growing in popularity on the theory that two of the complex electronic devices -- like two ears -- are better than one. Research shows people with two implants can locate sound more easily, differentiate speech from background noise and speak and understand better.

Despite the benefits, the procedure is controversial. Some people object to using limited health-care dollars to pay for a second implant when some patients can't get a first. And some within the deaf community view deafness not as a disability that needs to be cured but as part of their culture and identity.

"I personally have been encouraged to have (an implant), but I am against it," Kevin Martin, president of the Kentucky Association of the Deaf, said in an e-mail. "God made me who I am and I've grown up to accept that."

Nationally, about 10,000 children have cochlear implants, and the California nonprofit Let Them Hear Foundation says more than 1,600 children have the double or "bilateral" implants.

While there are no reliable state-by-state numbers on bilateral implants, doctors agree that the number is small but growing in Kentucky. Jaden's physician, Dr. Mark Severtson of Louisville, has placed second implants in two children and plans a third soon, and University of Kentucky doctors have placed them in one child and four adults.

Eventually, doctors and audiologists expect bilateral implants to become the norm -- especially if more insurance companies agree to pay for the procedure. Already, "It's kind of become the gold standard," said Mary Burton, an audiologist at Heuser Hearing Institute in Louisville.

Jaden will hear for the first time out of his left ear when doctors turn on his implant April 15. He will then require therapy to learn to hear from it.

Balancing on a log near his grandparents' driveway, he ticked off the things he can't wait to hear better: "I like to hear songs. I like to hear TV. I like to hear noise. I like to hear anything."

John Young said he wishes Rhyne could see Jaden today.

"This was her dream, for him to hear as we do," said Young, 29. "It's a miracle."

Recognizing sound
Shortly after Jaden's birth, his parents heard about cochlear implants, which stimulate the auditory nerve and send signals to the brain that are recognized as sound. One part of the implant is placed beneath the skin and another sits on the head behind the ear.

Rhyne asked doctors to implant one as soon as possible, and Jaden had surgery a couple of days after his first birthday, shortly after the federal government approved the devices for children that young.

A month later, doctors turned on the device, and Jaden practically jumped in his father's arms when he heard cars rumble by on nearby Interstate 65.

He soon began making sounds, saying his first word -- "Mommy" -- when he was 3.

With the help of therapists, Jaden eventually learned to talk. He picked up sign language by spending time in a class with deaf children at Brandeis Elementary School, but mostly communicated through speech.

Severtson, clinical associate professor of otolaryngology at the University of Louisville, attributed Jaden's progress partly to the timing of his implant. "The earlier, the better," he said.

But it wasn't a panacea. Jaden still searched to find where sounds were coming from, and had problems saying some words.

The family was dealt a huge blow when Rhyne, 29, was killed after stepping out of her car on Outer Loop. The case remains unsolved.

Through his grief, Young, an ironworker, held out hope that his son would someday hear with both ears.

When Young picked up a replacement part for Jaden's first implant, Burton told him Jaden was a candidate for a second. Although many insurance plans don't cover second implants -- which can cost as much as $80,000 including the hospital stay and doctor fees -- Jaden's Passport Medicaid plan did.

"In my heart I believe it was a gift from his mother," Young said of how it came together.

For the March 13 surgery at Kosair Children's Hospital, Jaden brought his "Courage Lion," a stuffed animal with a picture of his mother in a red frame on the belly.

Directional hearing
Many doctors and audiologists say bilateral implants allow children to move more easily between the deaf and hearing worlds, and can help them in school, in sports and eventually with driving.

Ann Chumbley of Louisville plans to give her daughter Addie those benefits. Born with hearing loss, Addie, 7, stopped making noise at 14 months and was discovered to be deaf.

She received her first implant at 26 months, and is scheduled to get her second in June. Chumbley said Addie has done well with one, succeeding in school and even taking piano lessons. But she has trouble hearing cars on their street.

"Hopefully with two she'll have directional hearing. It is a big safety issue," Chumbley said. Down the road, "I want her to have all the opportunities for school and college and for being an adult and being successful."

But members of the deaf community argue that people can live successful lives without implants.

Martin said he believes some doctors are pressuring parents, telling them cochlear implants will be best for their children when they really just want the money. When parents force children to speak and hear, he said, the results are often poor, and those children might do better with sign language.

"Bilateral cochlear implants are not appropriate for all deaf and hard of hearing children and adults," added Dr. Bobbie Scoggins, executive director of the Kentucky Commission on the Deaf and Hard of Hearing. "Cochlear implants are a tool to be used in some forms of communication, and not a cure for deafness. … Long-term effects and future technology improvements are yet unknown."

Dr. Arun K. Gadre, Heuser Hearing Institute Professor of Otology & Neurotology at U of L, said he realizes the benefits of having two implants, but questions the fairness of it. "There are a lot of people in this country who can't get a single cochlear implant," Gadre said. And with public insurance, he added, getting two "is obviously coming at the expense of somebody else."

Despite such criticisms, many echoed Severtson's view that getting two implants is "a matter of choice."

Young said it was the right choice for Jaden.

"If you can give a kid the opportunity to hear," Young said, "then why not?"

Reporter Laura Ungar can be reached at (502) 582-7190.

© 2007 The Courier-Journal.